Reintroducción de la circuncisión como una técnica quirúrgica reconstructiva / Reintroduction of Circumcision as a Technique Reconstructive Surgical

La circuncisión es una cirugía practicada frecuentemente en urología. Sin tener en cuenta los principios básicos de la cirugía reconstructiva, puede generar procesos de cicatrización anómalos, con resultados estéticos y funcionales inadecuados, fimosis secundaria, cicatrización hipertrófica, queloide o "pene enterrado." El objetivo de este video es recordar la importancia de operar con las directrices de una cirugía reconstructiva, resaltando el cuidado de los tejidos y el uso de suturas de bajo calibre, para prevenir complicaciones y resultados insatisfactorios, resaltando la preservación de las zonas postuladas por Firlit. Se sospecha que las complicaciones de este procedimiento son subestimadas por los especialistas. El manejo cuidadoso de los tejidos, el uso de suturas de bajo calibre y los puntos subcuticulares con poca tensión, son medios para optimizar el proceso de cicatrización, evitando la isquemia y las cicatrices hipertróficas, basados en el fundamento de que esta es una cirugía no solo funcional, sino reconstructiva y estética. La circuncisión es un procedimiento que debe conservar la funcionalidad y estética del pene, por lo que debe ser realizado bajo las directrices de una cirugía

Circumcision is a frequently practiced surgical procedure in urology. Without considering the basic principles of reconstructive surgery, it can result in abnormal cicatrization processes, with inadequate aesthetic or functional results, secondary phimosis, hypertrophic or keloid scarring, or even "buried penis." The objective of this video is to remind the importance of operating with the principles of reconstructive surgery, highlighting the careful handling of tissues and the use of low-caliber sutures, to prevent complications and unsatisfactory results, preserving the areas postulated by Firlit. The complications of this procedure are suspected to be underestimated by specialists. Careful tissue management, the use of low-caliber sutures and subcuticular points with no tension are means to optimize the healing process, avoiding ischemia and hypertrophic scars, based on the fact that this is a surgery that is not only functional, but reconstructive and aesthetic as well. Circumcision is a procedure that must preserve the functionality and aesthetics of the penis and it must be performed under the principles of reconstructive surgery.

Orientações de Enfermagem em casos de fimose na infância- Estudo descritivo / Nursing Guidelines in Cases of Childhood Fimosis - Descriptive Study / Orientaciones de Enfermería en Casos de Fimosis Infantil - Estudio Descriptivo

Objetivo: analisar as orientações que os pais/mães ou responsáveis pela criança recebem sobre o cuidado na fimose infantil por parte dos enfermeiros. Método: abordagem qualitativa e método descritivo, seguindo os pressupostos de Minayo, no qual as participantes foram entrevistadas por meio da plataforma digital do Google Forms. Resultados: Foram 10 entrevistadas que atenderam aos seguintes critérios de exclusão: ter filhos entre 1 ano à 2 anos de idade, onde responderam todas as categorias propostas referente a fimose. Conclusão: os pais/responsáveis precisam de mais orientações a respeito da fimose na infância e as complicações que podem causar se não diagnosticadas ainda na infância. Com isso podemos deixar uma alerta para os profissionais da saúde em especial aqueles que realizam atendimentos nas unidades básicas de saúde, durante as consultas de crescimento e desenvolvimento oriente os pais/responsáveis com clareza sobre essa patologia e suas possíveis complicações

Objective: to analyze the guidelines that the fathers/mothers or guardians for the child receive on the care of childhood phimosis. Method: qualitative approach and descriptive method, following Minayo's assumptions, no qualifications as participants were interviewed through the digital platform of Google Forms. Results: There were 10 interviewees who met the exclusion criteria: having children between 1 year and 2 years old, where they answered all the proposed categories referring to phimosis. Conclusion: parents/guardians need more guidance about childhood phimosis and the complications that it can cause if not diagnosed in childhood. With this, we can leave an alert for health professionals, especially those who provide care in basic health units, during the growth and development consultations, guide parents/guardians with clarity about this pathology and its possible complications.

Objetivo: analizar las orientaciones que reciben los padres os tutores del niño sobre los cuidados en la fimosis infantil. Método: enfoque cualitativo y método descriptivo, siguiendo los supuestos de Minayo, en el cual los participantes fueron entrevistados a través de la plataforma digital de Google Forms. Resultados: Fueron 10 entrevistados que cumplieron con los siguientes criterios de exclusión: tener hijos entre 1 año y 2 años, donde respondieron todas las categorías propuestas en cuanto a fimosis. Conclusión: los padres / tutores necesitan más orientación sobre la fimosis infantil y las complicaciones que puede causar si no se diagnostica en la infancia. Con esto, podemos dejar una alerta para los profesionales de la salud, especialmente aquellos que brindan atención en las unidades básicas de salud, durante las consultas de crecimiento y desarrollo, orientar a los padres / tutores con claridad sobre esta patología y sus posibles complicaciones.

A percepção de mulheres histerectomizadas sobre os cuidados da enfermagem no processo cirúrgico / The perception of hysterectomized women about the care for the disease and the surgical process / La percepción de las mujeres histerectomizadas sobre el cuidado de la enfermedad y el proceso quirúrgico

Objetivo: analisar as orientações que os pais/mães ou responsáveis pela criança recebem sobre o cuidado na fimose infantil por parte dos enfermeiros. Método: abordagem qualitativa e método descritivo, seguindo os pressupostos de Minayo, no qual as participantes foram entrevistadas por meio da plataforma digital do Google Forms. Resultados: Foram 10 entrevistadas que atenderam aos seguintes critérios de exclusão: ter filhos entre 1 ano à 2 anos de idade, onde responderam todas as categorias propostas referente a fimose. Conclusão: os pais/responsáveis precisam de mais orientações a respeito da fimose na infância e as complicações que podem causar se não diagnosticadas ainda na infância. Com isso podemos deixar uma alerta para os profissionais da saúde em especial aqueles que realizam atendimentos nas unidades básicas de saúde, durante as consultas de crescimento e desenvolvimento oriente os pais/responsáveis com clareza sobre essa patologia e suas possíveis complicações.

Objective: to analyze the guidelines that the fathers/mothers or guardians for the child receive on the care of childhood phimosis. Method: qualitative approach and descriptive method, following Minayo's assumptions, no qualifications as participants were interviewed through the digital platform of Google Forms. Results: There were 10 interviewees who met the exclusion criteria: having children between 1 year and 2 years old, where they answered all the proposed categories referring to phimosis. Conclusion: parents/guardians need more guidance about childhood phimosis and the complications that it can cause if not diagnosed in childhood. With this, we can leave an alert for health professionals, especially those who provide care in basic health units, during the growth and development consultations, guide parents/guardians with clarity about this pathology and its possible complications.

Objetivo: analizar las orientaciones que reciben los padres os tutores del niño sobre los cuidados en la fimosis infantil. Método: enfoque cualitativo y método descriptivo, siguiendo los supuestos de Minayo, en el cual los participantes fueron entrevistados a través de la plataforma digital de Google Forms. Resultados: Fueron 10 entrevistados que cumplieron con los siguientes criterios de exclusión: tener hijos entre 1 año y 2 años, donde respondieron todas las categorías propuestas en cuanto a fimosis. Conclusión: los padres / tutores necesitan más orientación sobre la fimosis infantil y las complicaciones que puede causar si no se diagnostica en la infancia. Con esto, podemos dejar una alerta para los profesionales de la salud, especialmente aquellos que brindan atención en las unidades básicas de salud, durante las consultas de crecimiento y desarrollo, orientar a los padres / tutores con claridad sobre esta patología y sus posibles complicaciones.

Postoperative aesthetic and healing features of postectomy using three different surgical techniques: a randomized, prospective, and interdisciplinary analysis / Aspectos estético e cicatricial pós-operatórios da postectomia por três diferentes técnicas cirúrgicas: análise randomizada, prospectiva e interdisciplinar

ABSTRACT Objective: to compare the postoperative esthetic and healing aspects of postectomy performed by different surgical techniques, based on the evaluation of different specialty expert professionals. Methods: prospective and randomized clinical trial enrolling 149 preschool children with a medical indication for circumcision, divided into three groups: postectomy with the hemostatic device Plastibell® (PB group), conventional technique (CV group) and conventional with subcuticular stitches (SC group). Pictures were taken from patients at pre-defined angles on the 30th and 60th postoperative days. Photos were evaluated by three specialists (dermatologist, pediatrician and plastic surgeon), who assigned scores from 1 to 5 regarding the esthetic and healing features at each moment. Grades 4 or 5 from all specialists characterized "best result". Data were analysed to compare the used surgical techniques, the judgments from specialties and postoperative complications. Results: most of the patients obtained the "best result" regarding healing (70%) and esthetics (56%). The final overall result showed the PB group as the best for healing (p=0.028) and the SC group as the best for esthetics (p=0.002). For the dermatologist, on the 60th postoperative day, the CV group presented the worst aesthetic result, whereas for the pediatrician and the plastic surgeon, the PB group presented the best healing result and the SC group had the best esthetic result. There was no difference between the groups regarding the presence of complications. Conclusion: the most common surgical techniques used to perform postectomy in children were differently assessed regarding healing and esthetic features by distinct medical professionals. The analysis of these two parameters among experts from related areas diverged among them and over time.

RESUMO Objetivo: analisar os aspectos estético e cicatricial pós-operatórios (PO) de pacientes submetidos a postectomia por diferentes técnicas cirúrgicas a partir da avaliação de profissionais experientes de áreas afins. Método: ensaio clínico prospectivo e randomizado, incluindo 149 meninos em idade pré-escolar com indicação médica de postectomia, divididos em três grupos: postectomia com dispositivo hemostático Plastibell® (grupo PB), técnica convencional (grupo CV) e convencional com pontos subcuticulares (grupo SC). Os pacientes foram fotografados em ângulos predefinidos no 30º e 60º dias de PO e as fotos avaliadas por três especialistas (dermatologista, pediatra e cirurgião plástico) que atribuíram notas entre 1 e 5, quanto aos aspectos estético e cicatricial em cada momento. Notas 4 ou 5 de todos os especialistas caracterizaram o "melhor resultado". Os dados foram submetidos à análise estatística para comparar as técnicas cirúrgicas, as avaliações dos especialistas e as complicações pós-operatórias. Resultados: a maioria dos pacientes obteve "melhor resultado" cicatricial (70%) e estético (56%). O resultado geral final apontou o grupo PB como superior quanto à cicatrização (p=0,028) e o grupo SC quanto ao aspecto estético (p=0,002). Para o dermatologista, na segunda avaliação, o grupo CV apresentou o pior resultado estético, enquanto para o pediatra e o cirurgião plástico, o grupo PB apresentou o melhor resultado cicatricial e o grupo SC o melhor resultado estético. Não houve diferença entre os grupos quanto à presença de complicações. Conclusão: as técnicas cirúrgicas mais empregadas para realizar postectomia em crianças foram avaliadas quanto aos resultados cicatricial e estético de distintas maneiras. A análise desses dois parâmetros entre especialistas de áreas afins divergiu entre eles e ao longo do tempo.

Miasis genital como complicación de circuncisión debido a fimosis: reporte de caso / Genital myiasis as complication of circumcision due to phimosis: case report

Resumen La circuncisión es un procedimiento quirúrgico de baja complejidad; el riesgo de complicaciones oscila entre el 0,2 a 5%, siendo la miasis un hecho poco frecuente. Para su tratamiento, principalmente se extraen las larvas, y se administran antiparasitarios y antibióticos para prevenir la infección secundaria. El objetivo del artículo es reportar el caso de un adulto masculino, quien presentó miasis genital posterior a una circuncisión y biopsia. En la mayoría de los casos, la miasis es accidental en humanos, y su verdadera incidencia es difícil de establecer debido al subregistro. La mala higiene, el bajo nivel socioeconómico y el hacinamiento son factores de riesgo importantes para adquirirla, además de la excesiva exposición del hospedero potencial a las moscas. Es fundamental realizar un correcto tratamiento de heridas y un seguimiento estricto del paciente que recibe manejo quirúrgico. MÉD.UIS.2019;32(2):41-6

Abstract Circumcision is a non complex surgical procedure, but is not a harmless option. Risk of complications may fluctuate between 0,2% and 5%, being myiasis a low often situation, for its treatment mainly the larvae are extracted, antiparasitics and antibiotics are administered to prevent secondary infection. The objective of the article is to report the case of a male adult, who presented genital myiasis after a circumcision and biopsy. In most of cases myiasis is accidental in humans and its true incidence is very hard to establish due to underreporting. Poor hygiene, low socio-economic level and overcrowding, are risk factors to obtain it, besides an excessive exposure to flies. A right wounds treatment and a strict monitoring of patient in surgical management is essential. MÉD.UIS.2019;32(2):41-6

Surgical plane positioning with a disposable circumcision suture device for the treatment of phimosis and redundant prepuce / 中华男科学杂志

<p><b>Objective</b>To investigate the clinical effects of circumcision by surgical plane positioning with a disposable circumcision suture device in the treatment of phimosis and redundant prepuce.</p><p><b>METHODS</b>From September 2016 to June 2017, we treated 250 patients with phimosis or redundant prepuce, 127 by conventional circumcision (the control group) and the other 123 by surgical plane positioning with a disposable circumcision suture device (the observation group). We compared the operation time, intra-operative bleeding, preputial frenulum alignment, postoperative ecchymosis, and postoperative penile appearance between the two groups of patients.</p><p><b>RESULTS</b>Compared with the controls, the patients in the observation group showed significantly longer operation time (［4.48 ± 1.18］ vs ［7.17 ± 1.42］ min, P<0.05), lower rates of intra-operative frenulum bleeding (15.0% ［19/127］ vs 4.1% ［5/123］, P<0.05) and frenulum misalignment (26.8% ［34/127］ vs 0.8% ［1/123］, P<0.05), higher incidence of postoperative ecchymosis (41.7% ［53/127］ vs 21.1% ［26/123］, P<0.05), and higher satisfaction of the patients with the postoperative penile appearance (92.9% ［18/127］ vs 98.4% ［121/123］, P<0.05). However, no statistically significant difference was found between the control and observation groups in intra-operative non-frenulum bleeding (4.7% ［6/127］ vs 1.6% ［2/123］, P = 0.164).</p><p><b>CONCLUSIONS</b>Circumcision by surgical plane positioning with a disposable circumcision suture device can effectively avoid preputial frenulum misalignment, reduce intra-operative bleeding, and improve postoperative penile appearance.</p>

HPV infection of the external genitalia in men whose female partners have cervical HPV infection / 中华男科学杂志

<p><b>Objective</b>Human papilloma virus (HPV) is a necessary cause of cervical cancer and is also closely related to penile cancer, oropharyngeal cancer, and anal cancer in males. However, few studies are reported on male HPV. This study aimed to investigate HPV infection of the external genitalia in men whose female partners have cervical HPV infection.</p><p><b>METHODS</b>We collected the relevant data on the male outpatients whose partners had cervical HPV infection in our Department of Urology and Andrology from August to December 2016. We obtained samples with nylon swabs from the glans penis, corona, inner layer of the prepuce and penile body and detected different types of HPV infection using the Hybribio HPV typing kit, PCR and membrane hybridization.</p><p><b>RESULTS</b>Valid data were collected from 140 males, which showed 83.5% of HPV infection of the external genitalia, including 60 cases of HPV6 (43.2%), 27 cases of HPV16 (19.4%), 14 cases of HPV39 (10.1%), 13 cases of HPV18 (9.4%), 13 cases of HPV58 (9.4%), and 13 cases of HPV52 (9.4%). Redundant prepuce was found in 75.5% of the males, but there was no statistically significant difference in the incidence rate of HPV infection between the normal and redundant prepuce groups (P > 0.05).</p><p><b>CONCLUSIONS</b>Men who have the female partners with positive cervical HPV are at high risk of HPV infection and therefore need to be screened and treated so as to reduce HPV infection in both sexes.</p>

Eficácia do uso de corticoides tópicos no tratamento da fimose primária em crianças e adolescentes / Efficacy of topical corticosteroids in the treatment of primary phimosis in children and adolescents / Eficacia del uso de corticoesteroides tópicos en el tratamiento de la fimosis primaria en niños y adolescentes

Introdução: A fimose primária é um problema frequente na consulta de saúde infantil, com prevalência de 11% aos 3 anos de idade. Objetivo: O objetivo desta revisão é avaliar a evidência da eficácia do uso de corticoides tópicos (CCT) na redução da limitação da retratilidade do prepúcio em crianças e adolescentes. Métodos: Pesquisa efetuada nas bases de dados National Guideline Clearing House, Canadian Medical Association Pratice Guidelines Infobase, Cochrane Library, DARE, Bandolier, Evidence Based Medicine Online, Trip Database Online e Pubmed, utilizando os descritores "Phimosis and steroids". Pesquisaram-se normas de orientação clínica (NOC), meta-análises, revisões sistemáticas e ensaios clínicos aleatorizados e controlados (ECAC), nas línguas portuguesa, inglesa e espanhola. Foi usada a escala Levels of Evidence of Oxford Centre for Evidence Based Medicine. Resultados: Foram encontrados 148 artigos, dos quais 6 cumpriram os critérios de inclusão: 1 NOC e 5 ECAC. A orientação da Sociedade Europeia de Urologia Pediátrica publicada em 2013 recomenda o uso de CCT na fimose primária. Os ECAC incluíram no total 624 crianças e adolescentes entre os zero e os 15 anos. Foram testados diferentes CCT e esquemas terapêuticos. Verificou-se uma melhoria da retratilidade do prepúcio comparativamente com o placebo, com uma eficácia terapêutica dos CCT descrita entre 66% e 90%. Conclusão: Os estudos suportam a eficácia dos CCT no tratamento da fimose primária em crianças e adolescentes. No futuro é pertinente o desenho de estudos metodologicamente homogêneos e de maior dimensão para clarificar qual o melhor CCT e esquema terapêutico.

Introduction: Primary phimosis is a frequent problem in child health clinic with a prevalence of 11% at 3 years of age. Objective: The aim of this review is to evaluate the efficacy of topical corticosteroids (CCT) in reduction of foreskin retractile limitation in children and adolescents. Methods: The research was performed using the National Guideline Clearing House, Canadian Medical Association Practice Guidelines InfoBase, Cochrane Library, DARE, Bandolier, Evidence Based Medicine Online, Trip Database Online and PubMed databases using the terms "phimosis and steroids". Clinical guidelines, meta-analyses, systematic reviews and randomized controlled trials (RCTs) were searched in Portuguese, English and Spanish. The Levels of Evidence of Oxford Centre for Evidence Based Medicine were used. Results: A total of 148 articles were found, of which only six fulfilled the inclusion criteria: one guideline and five RCTs. Since 2013 the European Society of Pediatric Urology recommends the use of CCT in primary phimosis. The RCTs included a total of 624 children and adolescents aged between zero and 15 years and different CCTs and therapeutic approaches were tested. A significant improvement in prepuce retraction was observed with the use of CCT compared to placebo achieving a therapeutic efficacy of 66% and 90%. Conclusion: The studies used in this work support the use of CCTs in the treatment of primary phimosis in children and adolescents. However, we consider to be of added value the implementation of larger and methodologically homogeneous studies in order to clarify what is the best CCT therapeutic method.

Introducción: La fimosis primaria es un problema común en la consulta médica con una prevalencia del 11% a los 3 años de edad. Objetivo: El objetivo de esta revisión es evaluar la evidencia de la eficacia de los corticoesteroides tópicos (CCT) en la reducción de la limitación de retractilidad del prepucio en niños y adolescentes. Métodos: Se realizaron encuestas en las bases de datos de National Guideline Clearing House, Canadian Medical Association Pratice Guidelines Infobase, Cochrane Library, DARE, Bandolier, Evidence Based Medicine Online, Trip Database Online e Pubmed, utilizando las palabras clave "phimosis and steroids". Se incluyeron guidelines, revisiones sistemáticas, metaanálisis y ensayos controlados aleatorios (ECA), en portugués, inglés y español. Se utilizó la escala Levels of Evidence da Oxford Centre for Evidence Based Medicine. Resultados: Se han encontrado 148 artículos, de los cuales seis cumplieron los criterios de inclusión: 1 guideline y 5 ECA. La guideline de la Sociedad Europea de Urología Pediátrica publicada en 2013 recomienda el uso de CCT en la fimosis primaria. El ECA incluyó un total de 624 niños y adolescentes de entre cero y 15 años. Se ha mejorado la retractilidad del prepucio en comparación con el placebo a una efectividad terapéutica del CCT descrito entre 66% y 90%. Conclusión: Los estudios apoyan la efectividad del tratamiento con corticoesteroides en la fimosis primaria en niños y adolescentes. En el futuro es apropiado el diseño de estudios metodológicamente homogéneos y más grandes para probar cual es el mejor tratamiento de CCT.

Observation time and spontaneous resolution of primary phimosis in children / Tempo de observação e resolução espontânea de fimose primária em crianças

ABSTRACT Objective: to investigate spontaneous resolution rate of a series of patients with physiologic phimosis in relation to observation time and presence of symptoms. Methods: retrospective and longitudinal follow-up study of patients with physiologic phimosis, that did not apply topic treatment. These patients were invited for a new visit for reevaluation, or recent data were obtained by chart analysis. Spontaneous resolution rate was determined and statistically compared to age, presence of symptoms at first medical visit and time until reevaluation. Results: seventy one patients were included. Medium time of observation from first visit to reevaluation was 37.4 months. There was spontaneous resolution of phimosis in 32 (45%) patients. Children with spontaneous resolution were younger at initial diagnosis and were observed during a longer period of time. Most asymptomatic patients at first visit presented spontaneous resolution. However, it was not possible to stablish a significant relationship between presence of symptoms and evolution of physiologic phimosis. Conclusions: time of observation was the main determinant of spontaneous resolution of patients with physiologic phimosis, reinforcing the current more conservative approach regarding circumcision of those patients.

RESUMO Objetivo: investigar a taxa de resolução espontânea de uma série de pacientes com diagnóstico de fimose fisiológica e sua relação com o tempo de observação e com a presença de sintomas. Métodos: estudo retrospectivo e de seguimento longitudinal e observacional de pacientes em acompanhamento por fimose fisiológica, que não haviam realizado tratamento tópico. Estes pacientes foram convocados para uma consulta médica de reavaliação ou tiveram dados recentes obtidos a partir da análise dos prontuários. A taxa de resolução espontânea foi determinada e comparada estatisticamente de acordo com a idade, com a presença de sintomas no momento da primeira consulta e com o tempo transcorrido entre a primeira consulta e a reavaliação. Resultados: setenta e um pacientes foram incluídos no estudo. O tempo médio de observação, entre a primeira consulta e a reavaliação foi de 37,4 meses. Houve resolução espontânea da fimose em 32 (45%) pacientes. As crianças que apresentaram resolução espontânea eram mais jovens no momento do diagnóstico inicial e foram observadas por um maior intervalo de tempo. A maior parte dos pacientes assintomáticos na primeira consulta apresentou resolução espontânea. No entanto, não foi possível estabelecer uma relação significativa entre a presença de sintomas e a evolução da fimose fisiológica. Conclusões: o tempo de observação foi o maior determinante para a resolução espontânea de pacientes com fimose fisiológica, o que reforça a tendência atual mais conservadora em relação às indicações de circuncisão para estes pacientes.

Novas perspectivas no diagnóstico e tratamento da acropostite-fimose em touros / New perspectives in the diagnosis and treatment of acropostitis-phimosis of bulls

A acropostite-fimose é um processo inflamatório da extremidade do prepúcio, diagnosticada com frequência em touros. O presente estudo objetivou avaliar o exame ultrassonográfico na definição da viabilidade do folheto prepucial interno (FPI) e na evolução clínica do pós-operatório, após o emprego de fios de categute ou poliglactina na hemostasia e de algodão ou poliglactina na confecção de sutura padrão Donatti empregada para fixar o FPI à pele prepucial no transoperatório da acropostite-fimose em touros. A sutura utilizada foi captonada ou não captonada, e os animais submetidos ao procedimento cirúrgico apresentavam no mínimo dois terços do FPI viável. Os touros foram alocados, aleatoriamente, em quatro grupos contendo nove animais cada, de acordo com o fio empregado na hemostasia e na confecção da sutura padrão Donatti. O exame ultrassonográfico mostrou-se importante na indicação ou não do tratamento cirúrgico da acropostite-fimose e possibilitou localizar lesões, mensurar a área de reação tecidual e identificar lesões profundas e pontos de estreitamento do FPI. Os animais de GII apresentaram edema mais discreto, observando-se diferença significativa (P<0,05) entre GII e os grupos GI, GIII e GIV. A ocorrência de hiperemia no sétimo dia de pós-operatório também foi menor nos touros do grupo GII, ocorrendo diferença significativa (P<0,05) entre GII e os grupos GI e GIII. A sutura empregando o dispositivo de látex (cápton) e o emprego do fio de poliglactina apresentaram-se como medidas benéficas, resultando em menor número de complicações pós-operatórias.(AU)

Acropostitis-Phimosis is an inflammatory process of the extremity of the prepuce, frequently diagnosed in bulls. The present study aimed to evaluate ultrassound exams in the definition of viability of the internal layer of prepuce and the postoperative clinical evolution. This evaluation is after the employment of catgut or poliglactin threads in homeostasis, and cloth or polyglactin threads in confection of the standard suture, Donatti, used to fix the internal layer of prepuce to the preputial in the postoperative of acropostitis-phimosis in bulls. The suture was captonated and non-captonated and the animals conducted to the surgical procedure showed at least 2/3 of viability of the internal layer of prepuce. The bulls were randomly allocated in four groups, each one containing nine animals, according to the thread used in homeostasis and confection of the Donatti standard suture. Ultrassound was shown to be important in the indication or not of the surgical treatment of acropostitis-phimosis and allowed the identification of lesions, measurement of areas of tissue reaction and locate deep lesions and narrowing points of internal layer of prepuce. The employment of latex device (capton) in suture and the employment of polyglactin thread 910 were shown as beneficial measures, resulting in a lower number of postoperative complications.(AU)

Novel penile circumcision suturing devices versus the shang ring for adult male circumcision: a prospective study

ABSTRACT Introduction To evaluate the safety and efficacy of a novel penile circumcision suturing devices PCSD and Shang ring (SR) for circumcision in an adult population. Materials and Methods A total of 124 outpatients were randomly assigned to receive PCSD (n=62) or SR (n=62). Patient characteristics, operative time, blood loss, return to normal activities time (RNAT), visual analogue scale (VAS), scar width, wound healing time, cosmetic result, and complications were recorded. Results There were no significant differences in blood loss, RNAT, or complications between the two groups. There were no significant differences in the VAS scores at the operation, at 6 or 24 hours after surgery (P>0.05). The wound scar width was wider in the SR group than in the PCSD group (P<0.01). Patients in the SR group had significantly longer wound healing time compared with those in the PCSD group (P<0.01). Patients who underwent PCSD were significantly more satisfied with the cosmetic results (P<0.01). Conclusions SR and PCSD are safe and effective minimally invasive techniques for adult male circumcision. Compared with SRs, PCSDs have the advantages of faster postoperative incision healing and a good effect on wound cosmetics.

Topical application of clobetasol propionate cream in the treatment of phimosis in prepubertal children: A report of 237cases / 中华男科学杂志

Objective@#To investigate the clinical effect of 0.02% clobetasol propionate cream (CPC) on phimosis in prepubertal children.@*METHODS@#We retrospectively analyzed the clinical data about 237 prepubertal children with phimosis present at the Outpatient Department from June 2012 to December 2015. The patients were aged 2－14 (mean 8.6) years, all treated by topical application of 0.02% CPC to the narrowed opening and adhered part of the foreskin twice a day, in the morning and evening respectively. At the time of CPC application, the foreskin was slightly retracted. We evaluated the therapeutic effect every week from the end of the first week of treatment.@*RESULTS@#Totally, 233 of the patients completed the 8-week treatment, of whom 181 (77.68%) showed full retraction of the foreskin, 28 (12.01%) experienced improvement (disappearance of the phimotic ring), and 24 (10.30%) failed to respond, with a total effectiveness rate of 89.70%. No significant local or systemic adverse reactions were observed during the treatment.@*CONCLUSIONS@#Topical application of 0.02% Clobetasol Propionate Cream is a safe, effective, painless, and inexpensive option for the treatment of phimosis in prepubertal chilodren.

A novel disposable circumcision device versus conventional surgery in the treatment of redundant prepuce and phimosis / 中华男科学杂志

Objective@#To compare the clinical effect of a novel disposable circumcision device Ring with that of conventional circumcision in the treatment of redundant prepuce and phimosis.@*METHODS@#Totally, 750 patients with redundant prepuce or phimosis underwent Ring circumcision (group A, n = 450) or conventional circumcision (group B, n = 300). We recorded the operation time, intraoperative blood loss, Visual Analogue Scale (VAS) intraoperative pain scores, postoperative complications, wound healing time, and patients' satisfaction with postoperative penile appearance, followed by comparison of the collected data between the two groups of patients.@*RESULTS@#All the operations were successfully completed. Group A, as compared with B, showed significantly shorter operation time (［3.78 ± 0.42］ vs ［26.24 ± 3.99］ min, P 0.05) or the postoperative incidence rate of edema (0.89% ［4/450］ vs 2.33% ［7/300］, P >0.05). There were no significant postoperative infections or delayed incision healing except for 1 case of wound dehiscence in each group.@*CONCLUSIONS@#Ring circumcision, with its advantages of shorter operation time, less blood loss and pain, higher safety, and better postoperative penile appearance, is easily accepted by the patients and deserves wide clinical application.

A novel disposable ring versus the suture device in circumcision / 中华男科学杂志

Objective@#To investigate the clinical effect of a novel disposable ring versus that of the suture device in circumcision for redundant prepuce and phimosis.@*METHODS@#We randomly assigned 470 male patients with redundant prepuce or phimosis to receive circumcision with a novel disposable ring (the DR group, n = 235) or the suture device (the SD group, n = 235) and compared the operation time, intraoperative blood loss, pain scores, wound healing time, and postoperative complications and penile appearance between the two groups of patients.@*RESULTS@#All the operations were completed smoothly. Compared with the SD group, the DR group showed significantly shorter operation time (［7.49 ± 1.84］ vs ［3.83 ± 0.42］ min, P 0.05) or while the staples scraping the underpants or at the ring removal (3.49 ± 1.22 vs 3.36 ± 1.41, P >0.05). No obvious postoperative infection or delayed healing was observed except for 3 cases of wound dehiscence (1 in the DR and 2 in the SD group) and 8 cases of delayed removal of the staples in the SD group.@*CONCLUSIONS@#The novel disposable ring, with its advantages of short operation time, less bleeding and pain, good penile appearance, high safety, and simple operation, is obviously superior to the suture device in circumcision and deserves to be applied and popularized clinically. .

Chinese parents' attitudes toward and their satisfaction with circumcision for 6－14 years old children / 中华男科学杂志

Objective@#To investigate the attitudes of the parents toward circumcision for 6－14 years old children and their satisfaction with the results.@*METHODS@#We performed circumcision in the Department of Urology of Zhongda Hospital for 220 children aged 6－14 years from 220 families between January 2010 and August 2016, including 70 cases of traditional and 150 cases of Shang Ring circumcision. We conducted telephone follow-ups among the parents of the patients concerning the decision-maker, reasons and regret for circumcision, acceptance of a second operation, source of information, satisfaction with surgical results, and reasons for dissatisfaction.@*RESULTS@#Most decisions for circumcision were made by the father, chiefly for health and hygiene. Their main sources of information on circumcision were Internet and friends. The parents of 29 patients were dissatisfied for long recovery or peri- and post-operative pain, including 19 cases (27.1%， 19/70) of traditional and 10 cases (6.7%， 10/150) of Shang Ring circumcision, with statistically significant differences between the two groups (P <0.05).@*CONCLUSIONS@#Most parents were satisfied with circumcision, and the main reasons for dissatisfaction were long recovery and pain. The rate of satisfaction with Shang Ring circumcision was higher than that with traditional circumcision. Shang Ring circumcision is recommended for children aged 6－14 years old.

Frenulum identification positioning with a disposable suture device in circumcision to prevent postoperative penile frenulum malposition / 中华男科学杂志

Objective@#To investigate the effect of the frenulum identification positioning method with a disposable suture device in circumcision for the prevention of postoperative penile frenulum malposition.@*METHODS@#Totally 212 patients with phimosis or redundant prepuce underwent circumcision from March 2015 to September 2016, including 109 cases of conventional circumcision (the control group) and 103 cases treated by frenulum identification positioning with a disposable suture device (the observation group). We observed the postoperative position of the penile frenulum and median raphe and compared the deviation angles of the frenulum between the two groups of patients.@*RESULTS@#The median of penile frenulum deviation angle (interquartile range) was 0 (3.56) in the observation group, significantly smaller than 12.41 (19.59) in the control (P <0.001, P = 0.000). And the rate of frenulum deviation was remarkably lower in the former (8.74% ［9/103］) than in the latter group (66.06% ［72/109］) (P <0.01).@*CONCLUSIONS@#Circumcision using the frenulum identification positioning method with a disposable suture device can effectively avoid postoperative penile frenulum malposition. With the advantages of safety and easy operation, it deserves clinical application and popularization.

Patologias genitais masculinas em cirurgia pediátrica de manejo / Outpatient pediatric surgery of male genital pathologies

Objetivos: Diagnosticar e manejar patologias comuns do trato genital masculino. Métodos: Revisão da literatura do ano de 2011 ao 2017 em base de dados PubMed. Resultados: Hipospádia é a localização anômala do meato uretral. Seu diagnóstico é clínico. As indicações cirúrgicas são anormalidades funcionais e estéticas. Fimose é descrita como impossibilidade de retração do prepcio para exposição da glande peniana, sendo um evento fisiológico quando apresenta resolução espontânea. Nos casos patológicos, o tratamento é primeiramente realizado com corticoide tópico. Se falha, o tratamento é cirúrgico. Hidrocele é o acúmulo de líquido na bolsa escrotal. O diagnóstico é clínico e por transiluminação escrotal. A maioria dos casos regride espontaneamente até os 24-36 meses. A cirurgia é considerada padrão-ouro para hidrocele comunicante na criança. Criptorquidia é a falha na migração do testículo até a bolsa escrotal. Seu diagnóstico é clínico, através da palpação testicular bilateral. Caso os testículos não estejam presentes na bolsa escrotal até os 6 meses de idade, a cirurgia é imprescindível, pelo risco de infertilidade e malignização. Conclusões: É essencial que o médico generalista saiba reconhecer tais condições com o intuito de iniciar prontamente o tratamento adequado, evitando suas complicações.

Aims: Diagnose and manage common pathologies of the male genital tract. Methods: Literary review of the last 6 years in the PubMed database. Results: Hypospadia is an anomalous location of the urethral meatus. The diagnosis is clinical. Surgical indications are functional and aesthetic abnormalities. Fimosis is described as impossibility of retraction of the foreskin to expose the penile glans, it is a physiological event when it presents spontaneous resolution. In pathological cases, treatment is first performed with topical corticosteroids. If it fails, the treatment is surgical. Hydrocele is the accumulation of fluid in the scrotal sac. The diagnosis is clinical and scrotal transillumination. Most cases regress spontaneously up to 24-36 months. Surgery is considered gold standard in cases of communicant hydrocele in children. Cryptorchidism is the failure of the migration of the testis to scrotal sac. The diagnosis is clinical through bilateral testicular palpation. If the testicles are not present in the scrotal sac until 6 months of age, surgery is essential, due to the risk of infertility and malignancy. Conclusions: It is imperative that the general practitioner knows how to recognize such conditions in order to promptly initiate appropriate treatment, avoiding complications.

A wet dressing for male genital surgery: A phase II clinical trial

ABSTRACT Purpose: This study was to confirm the safety and efficacy of BC dressing when used in surgical male wound healing at the urogenital area. Methods: Open, non-controlled clinical study of phase II. A total of 141 patients, among those children, adolescents and adults with hypospadias (112), epispadias (04), phymosis (13) and Peyronie's disease (12) that had a BC dressing applied over the operated area after surgery. A written informed consent was obtained from all participants. Study exclusion criteria were patients with other alternative treatment indications due to the severity, extent of the injury or the underlying disease. The outcomes evaluated were efficacy, safe and complete healing. The costs were discussed. Results: In 68% patients, the BC dressing fell off spontaneously. The BC was removed without complications in 13% of patients at the outpatient clinic during the follow-up visit and 17% not reported the time of removal. In 3% of the cases, the dressing fell off early. Complete healing was observed between 8th and 10th days after surgery. The BC dressings have shown a good tolerance by all the patients and there were no reports of serious adverse events. Conclusion: The bacterial cellulose dressings have shown efficacy, safety and that can be considered as a satisfactory alternative for postoperative wound healing in urogenital area and with low cost.

Pathological investigation of childhood foreskin: are lichen sclerosus and phimosis common?

Objective: To evaluate histopathological results of foreskin removed during circumcision in the pediatric age group and the relationship between these and the degree of phimosis

Study Design: Cross-sectional study

Place and Duration of Study: Department of Urology, Samsun Training and Research Hospital, Samsun, Turkey, from June to December 2014

Methodology: Male children undergoing planned circumcision were examined for the presence and degree of phimosis which was recorded before the operation. After circumcision, the preputial skin was dermatopathologically investigated. Pathological investigation carefully evaluated findings such as acute inflammation, chronic inflammation, increased pigmentation and atrophy in addition to findings of Lichen Sclerosus [LS] in all specimens. The pathological findings obtained were classified by degree of phimosis and evaluated

Results: The average age of the 140 children was 6.58 +/- 2.35 years. While 61 [43.6%] children did not have phimosis, 79 [56.4%] patients had different degrees of phimosis. Classic LS was not identified in any patient. In a total of 14 [10%] children, early period findings of LS were discovered. The frequency of LS with phimosis was 12.6%, without phimosis was 6.5% [p=0.39]. The incidence of histopathologically normal skin in non-phimosis and phimosis groups was 37.7% and 22.7%, respectively. In total, 41 [29.3%] of the 140 cases had totally normal foreskin

Conclusion: Important dermatoses such as LS may be observed in foreskin with or without phimosis. The presence of phimosis may be an aggravating factor in the incidence of these dermatoses

Circumcision versus the foreskin-deglove plus shaft-fix procedure for phimosis or redundant prepuce in obese adult patients / 中华男科学杂志

<p><b>OBJECTIVE</b>To compare the clinical effects of circumcision and the foreskin-deglove plus shaft-fix (FDSF) procedure in the treatment of phimosis or redundant prepuce in obese adult males (body mass index [BMI] ≥ 28 kg/m²).</p><p><b>METHODS</b>Forty-four obese adult men with phimosis or redundant prepuce underwent circumcision (n = 24) or FDSF (n = 20) according to their own wishes. The patients in the circumcision and FDSF groups were aged (26.38 ± 4.24) and (26.90 ± 3.14) years, with BMIs of (27.77 ± 0.77) and (28.07 ± 2.28) kg/m² and penis lengths of (3.51 ± 0.46) and (3.50 ± 0.59) cm, respectively. The operations were performed under local anesthesia with lidocaine plus ropivacaine mesylate.</p><p><b>RESULTS</b>The operation time of circumcision was (28.04 ± 2.65) min and that of FDSF was (45.45 ± 3.49) min. At 6 months after surgery, normal penile erection was found in all the patients, the penis length was significantly longer in the FDSF than in the circumcision group ([5.01 ± 0.73] vs [3.70 ± 0.47] cm) , and the rate of satisfaction with penile appearance was markedly higher in the former than in the latter group (3.25 ± 0.71 vs 2.83 ± 0.56).</p><p><b>CONCLUSION</b>The foreskin-deglove plus shaft-fix procedure under local anesthesia with lidocaine and ropivacaine mesylate may achieve desirable penile erection and appearance in the treatment of phimosis or redundant prepuce in obese adult patients.</p>